med-surg Understanding Genitourinary and Reproductive system

• position=knee chest position
• exam= DRE 
• prostate gland is palpated by inserting a gloved, lubricated finger into the rectum while the man is in knee to chest position. posterior lobe can be felt

• normal: slightly firm without lumps
• abnormal: hard or soft, enlarged

ultrasound then needle biopsy

subjective (subject states)- sexual abuse menstrual cycle(norm is 28 days), smoking and drinking, age of first menses, gravidas, para, abortion sexual history, have they seen gynecologist

female pelvic exam, inspect external genitalia, uterus(tenderness, size & shape), cervix(color changes), anus (hemorrhoids), inguinal nodes ( could indicate lymphoma) BSE, mammography, ultrasound, biopsy, hysterosalipinogram, bi manual palpitation, swabs/smears, endoscopies

ensure a comfortable non judgemental enviroment. ask if they smoke multiple sex partners, how often they have intercourse, if they masturbate, if any erection issues, able to ejaculate with orgasm, history of diabetes( diabetes constricts blood vessels so no erection b/c the vessels will not dilate d/t constriction

TSE, DRE, transrectal ultra soound blood test: PAP, PSA . Fertility test, semen analysis and cystourethroscopy

decreased testosterone secretion>> decreased spermatogenesis, gradual decrease in muscle and size and strength, hypertrophy of prostate gland>> urine retention and risk for fracture

decreased estrogen secretion>>increase in bone loss, ovulation and menstruation stop, atrophy of vaginal epithelium, increased cholesterol level, atrophy of urinary meatus and decreased urethral tone>> increased risk of C.A.D, increased incontinence risk for osteoporosis and fractures

• dye is injected into the uterurs until it comes out the ends of the fallopian tubes. identifying congenital abnormalities.
• PRE- laxative, suppository or enema, consent allergies
• POST- nausea, light headedness, signs of allergic reaction, promote comfort
• DISCHARGE-teach signs of infection, dye may stain clothing, provide perineal pad wear pad until vaginal drainage stops

• -salpingoscopy: to see inside fallopian tubes
• -hysteroscopy: to see inside of uterus 
• -colposcopy: studies lesions on the cervix the                scope passes the vagina 
• -culdoscopy: scope through vagina and incision into the vagina into the cul de sac of dougla cavity behind the uterus

• PRE-prepare according to institutional or facility protocol, fast as instructed, assess vital signs, recording of last time voiding, consent, general anesthesia, provide support 
• POST-provide comfort measure, almost no blood loss, may experience pain in neck shoulders and upper back. to help with insufflation pt should lie on back for a few hours
• PT ED- observe incision site for redness, bleeding or drainage see 1 week for suture removal  pad until draining stops, report foul smelling discharge

• 1. cyclic breast discomfort
• 2. fibrocystic Breast Disease
• 3. mastitis 
•  

risk- hereditary, smoking, high fat diet, increased alcohol intake, estrogen therapy, early menarche, late menopause

Dx- BSE yearly physical, ultrasound, biopsy (3-5 days for results)

• S/S- pain (last symptom), dimpling asymmetry, immovable painless lump 
• * must rule out tumor in pituitary (brain).
•  
• TREATMENT- radiation (yo shrink tissue) chemotherapy(kills all rapidly dividing cells) 
• hormone therapy (deprive hormones to cancer cells that stimulate their growth)
• targeted therapies (pg 970 med surg)

• -oral contraceptives: (progesterone & estrogen, estrogen and testosterone or estrogen only/ progesterone only (Complications="A.C.H.E.S" 
• -NSAIDS: ibprofen (motrin, nuprin, advil, aleve, toradol 
• antineoplasctics mesds (estrogen antagonists: nolvadex, anaststrozole etc pg 970 med surg txtbk

• mammoplasty- surgical modification of the breast. to restore normal shape after removal of cancerous tissues OR electively to increase the sixe or improve the shape of their breast.
• mastopexy-involves the removal of some skin and fat to correct sagging of breast 
• augmentation- surgery to increase the size of the breast (saline or silicone bag underneath pectoral muscles

• metastitis
• significant treatment of side effects 
• profound negative effect on pts self image

• 1. anxiety
• 2.risk for ineffective breathing pattern 
• 3. risk for ineffective tissue perfusion
• 4.risk for ineffective coping

• amenorrhea-menses absent for more than 6 months or three of the previous cycles (called primary amonorrhea when menarche has not occured by age 17. secondary amenorrhea when when menses are absent after menarche
• hypermenorrhea- menses lasting longer than 7 days
• hypomenorrhea- less than the expected amount of menstrual bleeding 
• menorrhagia- passing more than 80ml of blood per menses
• oligomenorrheamenstrual-cycles of more than 35 days 
• Polymenorrhea- menses more frequently than 21 day intervals

metabolic imbalance, stress, pregnancy, hormonal imbalance, kidney liver or thyroid disease, excessive weight gain or loss

• Dx- pap smear (panicolau) , laproscopy  vaginal culture, extensive blood  therapeutic measures d testing 
• Tx- D&C dialtion and cutterage( laser ablation of endometrial tissue), hysterectomy 
• Nursing Care- weigh used sanitary pads

painful menstruation

• condition in which functioning endometrial tissue is located outside the uterus and retrograde menstruation which is the backward leakage of blood and tissue  into the fallopian tubes during menstrual period.
•  VERY PAINFUL

medications or surgical removal of ovaries analgesic for pain

• antibiotics: clindamycin 
• anti-fungals: terazol, fluconazole
• antiprotozoal: flagyl

• associated with superabsorbent tampon use during menstruation. severe systemic infection with strains of staphhylococus aurues that produce an epidermal toxin
• prevention: avoid prolonged use and wash hands

• agenesis of structures means that they never developed in life
• hypoplasia= underdevloped
• imporforate= expected organs do not exist 
• dyspareunia= pain with intercourse

• cystocele-occurs when bladder sags into the vagnal space b/c of inadequate support (Tx= colporraphy)
•  
• rectocele-portion of the rectum sags into the vagina b/c of inadquate support (feeling of pressure, incontinence constipation and hemorrhoids.)(Tx- Kegels high fiber and posterior colporrhaphy)
•  

• pain with sexual intercourse or menses
• infertility
• spontaneous abortion or preterm labor
• prolapse of utrus, bladder or rectum into vagina or outside of the body

involeves the removal of the uterine contents through an abdominal incision in the same manner as a cesarean section.

• assess pt after for bleeding
• bleeding should not exceed that of a heavy period
• notify md if fever chills , excessive bleeding or foul smelling discharge occur
• abstain from sexual intercourse
• grief response analyze 
• support given 
• need for birth control assessed

grow very large (benign) and treated by hysterectomy or myomectomy-removal of only fibroid tumor and may be chosen for fertility

• benign growths that grow inside the uterus or on the cervix and may bleed after intercourse or between menstrual cycles 
• Tx: removed vaginally or trancervially by separating the stalk from the uterus and then stopping the bleeding

• cyts ono ovaries, hypertrophy of the corpus luteum  after ovulation, inflammation of the ovary. most are not removed unless they interfere with fertility  or potential cancer 
• Tx -laparoscopic surgery called laparotomy if cyst are painful heat to abdomen or back may promote comfort.

• S/S: r/t obstruction: decrease in size/ force of stream, difficulty in starting stream, dribbling, interrupted stream, retention and overflow 
•        r/t irritation: dysuria, nocturia and urgency
• Dx: Primary: DRE, urinanalysis, BUN, serum creatinine, PSA
•       Secondary: urodynamic flow studies, transrectal ultrasound TO BE CONTINUED MED SRUG PG -1014